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Predictors of deferral of treatment for hepatitis C infection in Australian clinics

Heather F Gidding, Matthew G Law, Janaki Amin, Graeme A Macdonald, Joe J Sasadeusz, Tracey L Jones, Simone I Strasser, Jacob George and Gregory J Dore, on behalf of the ACHOS investigator team
Med J Aust 2011; 194 (8): 398-402.

Summary

Objective: To determine uptake of treatment for hepatitis C virus (HCV) infection and predictors of deferral of treatment for HCV by using prospectively collected data from the Australian Chronic Hepatitis C Observational Study (ACHOS).

Design, patients and setting: Cohort study involving interview and medical record review at enrolment and routine follow-up clinic visits of patients with chronic HCV and compensated liver disease attending a national network of 24 HCV clinics between April 2008 and December 2009. Eligible patients were those who had not been previously treated, were enrolled within 6 months of their first clinic visit, were eligible for treatment and had been enrolled for at least 6 months.

Main outcome measure: Predictors of patients undergoing HCV treatment within the first 6 months of assessment.

Results: 1239 patients were enrolled in ACHOS, of whom 406 met the criteria for inclusion in the subcohort for this study. Among this subcohort, 171 (42%) received treatment within 6 months of their first clinic visit. Current injecting drug use (odds ratio [OR], 0.26; 95% CI, 0.08–0.77), past and current treatment for drug dependency (OR, 0.34; 95% CI, 0.18–0.67, and OR, 0.42; 95% CI, 0.22–0.81, respectively) and alcohol use above 20 g/day (OR, 0.20; 95% CI, 0.08–0.46) were independent predictors of deferral of treatment. At least one of these factors applied to 41% of the subcohort. Clinical factors, including HCV genotype, HCV RNA level, and stage of liver disease were not associated with deferral of treatment for HCV.

Conclusion: Factors related to drug and alcohol use, rather than clinical factors, influenced uptake of treatment for HCV. Further support for patients with drug and alcohol dependency is required to optimise treatment uptake.

  • Heather F Gidding1
  • Matthew G Law1
  • Janaki Amin1
  • Graeme A Macdonald2
  • Joe J Sasadeusz3
  • Tracey L Jones4,5
  • Simone I Strasser6,7
  • Jacob George8
  • Gregory J Dore9,1
  • on behalf of the ACHOS investigator team

  • 1 National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW.
  • 2 University of Queensland Diamantina Institute, Princess Alexandria Hospital, Brisbane, QLD.
  • 3 Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, VIC.
  • 4 Hepatitis Service, John Hunter Hospital, Newcastle, NSW.
  • 5 School of Nursing and Midwifery, University of Newcastle, Newcastle, NSW.
  • 6 AW Morrow Gastroenterology and Liver Centre, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW.
  • 7 Central Clinical School (Medicine), University of Sydney, Sydney, NSW.
  • 8 Storr Liver Unit, Westmead Millennium Institute and Westmead Hospital, University of Sydney, Sydney, NSW.
  • 9 HIV, Immunology, Infectious Diseases Clinical Services Unit, Sydney, NSW.


Acknowledgements: 

We acknowledge the following state health departments for funding the study: New South Wales Department of Health, Queensland Health, Victorian Government Department of Human Services, and the Department of Health, South Australia. We acknowledge Roche Products for providing funding for the development of the study database. The National Centre in HIV Epidemiology and Clinical Research is funded by the Australian Government Department of Health and Ageing. The views expressed in this article do not necessarily represent the position of the Australian Government. Members of the ACHOS investigator team and details of contributing clinics can be found in the Cohort profile (first annual report) at http://www.nchecr.unsw.edu.au/NCHECRweb.nsf/page/ACHOS.

Competing interests:

None identified.

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